Insomnia - Really Need Help

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
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Julie G
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Re: Insomnia - Really Need Help

Postby Julie G » Fri Apr 10, 2015 9:11 am

(((Lilly))) Little to add to all of this great advice...other than I care and YOU are worth it. Burning the candle at both ends seemed to work under age 50. In retrospect, it's .probably never a good idea for a 4/4 and impossible to healthily sustain over age 50. ❤️

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Re: Insomnia - Really Need Help

Postby Tincup » Fri Apr 10, 2015 10:06 am

Found my notes on the breathing technique:

This an excerpt from the book Natural Sleep by Philip Goldberg and Daniel Kaufman (1978, Rodale, out-of-print) for those who cannot find sleep. Describes some helpful breathing exercises.

Falling Asleep: The Kelly Method

•Lie either on your back or on either side, whichever you find more conducive to easy breathing. Make sure your room is dark, and well-ventilated. Use a pillow that is just high enough to keep your head straight, or perhaps tilted slightly back. Be sure not to have the head lean forward -- when it tilts slightly back, the throat and eye muscles are relaxed, and breathing is freer.

•Close your eyes lightly.

•Begin with a few very deep inhalations, filling the lungs and expanding the chest as much as possible. Then exhale fully, drawing in the abdomen to expel as much air as possible. Repeat this three times.

•At the end of the third exhalation, when the lungs are as empty as possible, hold your breath for as long as you can. Hold it until the impulse to breathe cannot be resisted easily. Then repeat the three deep breaths, again holding your breath at the end of the third exhalation.

By doing this, you are gradually accumulating carbon dioxide in the body. The three deep breaths restore the oxygen content of the blood and remove enough carbon dioxide to allow the breath to be held longer, and therefore for more carbon dioxide to be produced. The carbon dioxide makes the chemical balance of the blood more acidic, and it slows the activity of the nerves and the brain, preparing them for the onset of natural sleep.

It is important, however, not to take more than three deep breaths in any part of the cycle, to keep the carbon dioxide buildup at just the right level. If you deviate from Kelly's prescription, chances are the carbon dioxide will be eliminated and drowsiness will not come.

•When not breathing at the end of the third breath, keep the lungs as empty as possible to preven the carbon dioxide from being absorbed from the bloodstream by the lungs.
Do not fear that you are being deprived of oxygen. You have more than enough in your bloodstream to nourish your cells, and as soon as you resume normal breathing, your body will balance itself accordingly.

•To aid the breath retention, distract your mind from the effort by thinking of a song or a poem you can recite to yourself. Or, you may prefer to use one of the other imagination-aids that we will discuss later.

•Turn your eyes upward during the breathing exercises, since it has been found that the position is conducive to sleep.
After perhaps five to eight periods of maximum deep breaths (three per set) and long breath-holding, you will feel a strong desire to breathe normally. You will also feel more relaxed and eager to rest. Quite possibly you will have fallen asleep before you do this five times.

If, after eight repetitions, you still cannot fall asleep, try the following exercise. Do not use it, however, until you have mastered the first.
In this exercise you will again take in as deep a breath as you can, and exhale as much air as you can. Again, do this three times. After the third, however, instead of holding your breath, you will have a period of what Kelly calls "minimum breathing."
"Minimum breathing," says Kelly, "means breathing in and out so slightly that the movement of the air in the nostrils is just perceptible. The minimum breathing must be very shallow and the breaths very short."

•Do not fill the lungs with air. Keep the abdomen completely relaxed -- don't tense the muscles. Do this until you feel the urge to breathe more deeply. Then start another series of three maximally deep breaths and complete expulsions. After those three, repeat the minimum breathing again.

•Continue in this manner as long as necessary, and as long as it is comfortable. Remember not to strain. Be casual. You will find your mind drifting so much you will forget how many breaths you have taken, or maybe even what you are doing in the first place. That is fine. Don't regret such events, and don't strain to remain alert for the purpose of doing the exercise. The purpose, remember, is to do the opposite -- drift into oblivion. Indeed, this technique can often be so effective that you will drift off during the minimum breathing periods.

Remember to take "rest" periods of normal breathing between repetitions. And do not be discouraged if neither exercise works the first few times. We have found the Kelly method to be quite effective whenever we are agitated. It is also very helpful upon awakening during the night.

Sleep: Alternate Nostril Breathing

This is a traditional Yoga practice, customarily done before periods of meditation. It is remarkably calming, and is said to restore equilibrium to the nervous system. Do it sitting up in bed comfortably (if awakened in the night, you might find it helpful to just do it lying there).

•Place the tip of your right thumb against your right nostril. Place the middle and ring fingers against your left nostril. Keep your hand relaxed. Close the right nostril with the thumb and breath in through the left.

•Inhale slowly and easily with the body relaxed. The breath may be slightly deeper than usual, but make no effort to take in an extra quantity of air. Some sources recommend holding the breath for three or four seconds once it is inhaled. We have found that, when drowsy, such an attempt might be a strain. Let's keep it optional.

•When ready, exhale. But exhale through the right nostril, lifting the thumb and closing the left nostril with your other fingers. Exhale slowly, noiselessly, but without straining to go at any particular pace. Follow whatever pace is comfortable. (Some recommend inhaling and exhaling to a particular count - again, when drowsiness is being encouraged, this might cause strain.)

•After having exhaled, and perhaps held the breath momentarily, inhale through the right nostril, keeping the left one closed. When you have inhaled and feel the urge to exhale, switch nostrils, closing the right once again.

•The sequence, then, is as follows: out--in--switch nostrils--out--in--switch nostrils--out--in--switch nostrils...

You should do this alternate nostril technique for about five minutes. after you are accustomed to it, and it feels natural, you may increase to ten minutes, when necessary. Do not exceed ten minutes. Naturally, if you feel sufficiently drowsy, stop, lie down, and sleep.

If, at any point, you forget which nostril it is time to close, or whether to inhale or exhale, or if you forget for the moment why you fingers are at your nose, then the technique is working. You are likely to be drifting off into sleep.
There are no formal studies of these controlled breathing techniques, but the anecdotal evidence is substantial. That alternate-nostril breathing is a valuable aide in achieving relaxation is evidenced by its centuries of use in the Yoga tradition, and its increasing use in the West.

In our questioning of people who have tried many different techniques to improve their sleep, both the breathing practices described here have been given support. They can only help. If you do them some night and you still do not fall asleep easily, do not discard the technique. It may have been a particularly bad night.

{edit} Just found this related technique. Tried it - but not for sleep - & could feel the relaxation. Probably a CO2/parasympathetic technique too.
You simply breathe in through your nose for four seconds, hold your breath for seven seconds, and exhale through your mouth for eight seconds. She explained that the studied combination of numbers has a chemical-like effect on our brains, and would slow my heart rate and soothe me right to sleep that night.

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Re: Insomnia - Really Need Help

Postby circular » Fri Apr 10, 2015 11:09 pm

There are some amazing guided journeys at this site that help with managing all sorts of situations. I particularly like Belleruth Naperstak, although she sells some by others who she likes. She seems to appeal a lot to women. An amazing voice. See if you're led to any in particular. I doubt you'll be dissappoineted.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Insomnia - Really Need Help

Postby GenePoole0304 » Sat Apr 11, 2015 7:22 pm

no coffee or decaf after 300pm..

wear blue blocker glasses after 700pm..
no lights in bedroom, total darkness.
regular bedtime and getting up same time or you mess up your circadian rhythm.

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Re: Insomnia - Really Need Help

Postby sarahb12 » Sat Apr 11, 2015 10:30 pm

Oh sweetie...

Good advice people are giving, I will try some myself. A few thoughts.

* progesterone. My MD assures me that oral progesterone has helped most of his patients. If you are already taking it, it might be time to get remeasured - to see if you need more.

* I suffer from lack-of-sleep-o-phobia, which ironically kept me awake . I made a breakthrough a couple of decades ago when I read that if you lay perfectly still, you are getting some rest - the equivalent of 6hrs for 8 laying down - which was much more than I was getting. After not being so stressed about getting sleep, I slept better.

* I have a problem turning off my brain sometimes when there is stress. I think it is my Met^2 version of COMT. I finally figured out I could redirect my brain at a less stress-inducing but challenging task, like sudoku or something, then from there I could wind down.

I hope something helps.


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Re: Insomnia - Really Need Help

Postby MichaelR » Fri May 15, 2015 1:48 pm

Hi LB,

Sorry your sleep is so messed-up. I note that you say you've been taking "8 mg at bedtime (whenever that is)." A couple of things on that. As George N and Kitano have alluded, you may be encountering a paradoxical response to so high a dose. This isn't an ε4 thing (or, there is no research to suggest that): 0.3 mg (300 mcg) is sufficient to raise levels to normal physiological youthful ones (and actually, to supraphysiologic levels in older people(6)) and apparently works as well as higher doses ((1,2,4,5), and see (3)). Doses of 3 mg (and up) produce an excessive fall in body temperature and 'hangover' sleepiness.(4) I know that the most common dose in health food stores is 10 mg; this is thanks to the unfortunate recommendation of the once-notorious Melatonin Miracle, which was extrapolating from poorly-done rodent life extension studies.(7)

I will also note that one clinical trial found 2 mg of controlled-release M to improve not only sleep, but cognitive function and instrumental activities of daily living in people with mild-to-moderate AD (genotype undetermined). Whether this is just the effect of ameliorating the normal deleterious effects of sleep deprivation, or also had some effect on the disease itself, is unknown, and thus whether there's a rationale (beyond silly "it's an antioxidant!" arguments) for taking it preventively.

Also, you say you've been taking "8 mg at bedtime (whenever that is)." As you may know, the reason why M promotes sleep is that it's an endocrine regulator of circadian rhythms: it sends out the message from the central body clock that it's bed-time now and everyone should wrap up their daytime business. This is why it's particularly useful for jet lag per se. If you're taking an agent that entrains your circadian rhythm at different times night after night, I expect that you're going to bugger yourself up even worse over time. Additionally, a regular bedtime is a core element of "sleep hygiene," so if you're having trouble sleeping you should really be endeavoring to make this time as consistent as you can, M or no.

Also, you mention caffeine ... it's important to avoid C for at least 6 hours before bedtime. I know this may sound like a lot, and the U of M site I just linked indicates 4-6 h rather than 6, but a recent study finds that 400 mg of C interferes with proper sleep cycling for at least 6 h, even though the subjects did not subjectively notice any effect:
Caffeine-induced sleep disturbance was detected by both the self-report diary and objective sleep measures when taken at bedtime and 3 hours prior to bedtime, whereas only the objective measure detected differences when caffeine was taken 6 hours prior to bedtime.(9)
This would mean that you're not getting the full cognitive or tissue-repair benefits of what sleep you get, even if you're ostensibly asleep for the same amount of time. And they didn't test a window longer than 6 h, so it's at least possible that the effect is present even longer than that; indeed, you'd actually expect it to, particularly at higher dose, since 6 h is the average half-life of caffeine.

400 mg is the amount present in 1-4 cups of brewed coffee, depending on bean variability and strength and method of brew: an 8 oz cup of home-brew tends to contain ~100 mg, but (a) 12 oz is the least that almost anyone drinks at a time any more, and (b) tyical Starbucks and pressed coffees contain 400 mg. If you're actually having trouble even getting to or staying "asleep," I'd really urge you to wean yourself off of the afternoon caffeine habit.

(On the other hand, I'd encourage you not to go off C altogether: there's experimental and epidemiological evidence suggesting that moderate-to-high coffee consumption may reduce your risk of Alzheimer's, though the data are not strong and the epidemiology is quite inconsistent).

Hope that's useful. Sleep well soon!

1: Zhdanova IV, Wurtman RJ, Morabito C, Piotrovska VR, Lynch HJ. Effects of low oral doses of melatonin, given 2-4 hours before habitual bedtime, on sleep in normal young humans. Sleep. 1996 Jun;19(5):423-31. PubMed PMID: 8843534.

2: Zhdanova IV, Wurtman RJ, Lynch HJ, Ives JR, Dollins AB, Morabito C, Matheson JK, Schomer DL. Sleep-inducing effects of low doses of melatonin ingested in the evening. Clin Pharmacol Ther. 1995 May;57(5):552-8. PubMed PMID: 7768078.

3: Brzezinski A, Vangel MG, Wurtman RJ, Norrie G, Zhdanova I, Ben-Shushan A, Ford
I. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev. 2005 Feb;9(1):41-50. PubMed PMID: 15649737.

4: Zhdanova IV, Wurtman RJ, Regan MM, Taylor JA, Shi JP, Leclair OU. Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab. 2001 Oct;86(10):4727-30. PubMed PMID: 11600532.

5: Dollins AB, Zhdanova IV, Wurtman RJ, Lynch HJ, Deng MH. Effect of inducing nocturnal serum melatonin concentrations in daytime on sleep, mood, body temperature, and performance. Proc Natl Acad Sci U S A. 1994 Mar 1;91(5):1824-8. PubMed PMID: 8127888; PubMed Central PMCID: PMC43256.

6: Zhdanova IV, Wurtman RJ, Balcioglu A, Kartashov AI, Lynch HJ. Endogenous melatonin levels and the fate of exogenous melatonin: age effects. J Gerontol A Biol Sci Med Sci. 1998 Jul;53(4):B293-8. PubMed PMID: 18314560.

7: Pierpaoli W, Dall'Ara A, Pedrinis E, Regelson W. The pineal control of aging. The effects of melatonin and pineal grafting on the survival of older mice. Ann N Y Acad Sci. 1991;621:291-313. PMID: 1859093 [PubMed - indexed for MEDLINE]

8: Wade AG, Farmer M, Harari G, Fund N, Laudon M, Nir T, Frydman-Marom A, Zisapel N. Add-on prolonged-release melatonin for cognitive function and sleep in mild to moderate Alzheimer's disease: a 6-month, randomized, placebo-controlled, multicenter trial. Clin Interv Aging. 2014 Jun 18;9:947-61. doi: 10.2147/CIA.S65625. eCollection 2014. PubMed PMID: 24971004; PubMed Central PMCID: PMC4069047.

9: Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013 Nov 15;9(11):1195-200. doi: 10.5664/jcsm.3170. PubMed PMID: 24235903; PubMed Central PMCID: PMC3805807.

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Re: Insomnia - Really Need Help

Postby Stavia » Sat May 16, 2015 12:08 am

Thank you Michael for taking the trouble to type out this very useful information. I might add that in my country where a prescription is needed for melatonin, we use doses of 1 to 3mg. I am in the US on holiday and am bemused at the bottles of 5 to 10mg.

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Re: Insomnia - Really Need Help

Postby Julie G » Sat May 16, 2015 10:42 am

Wait till you get to Texas, Stavia, LOL :D I agree; great info from Michael. It's interesting to dovetail his perspective with our prior discussions: viewtopic.php?f=8&t=72

Now, we need an update from Lilly. Sleeping any better?

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